Welcome to Partnership in Action, a new series of updates on Labor Management Project initiatives in which labor, management and LMP staff members engaged in labor-management work tell us about the progress they’ve made, how they got there, and lessons they’ve learned along the way.
This month’s interview is with members of the labor-management committee from Mount Sinai Queens’ Imaging Services department, which has been successfully engaged in a number of performance improvement (PI) projects with the help of the LMP. Mount Sinai Queens staff were particularly inspired by the 2014 Institute for Healthcare Improvement (IHI) annual conference, where they presented results of a PI project at the poster session. They were also challenged by labor and management sponsors to improve patient satisfaction survey scores related to testing and treatment. We talked to the labor-management committee’s co-leads, Lead Technologist Rashid Larry and Administrative Director for Imaging Services George Lowe, as well as committee member Soraya Flores, medical secretary for Imaging Department, and the LMP’s consultant to Mount Sinai Queens, Regina Censullo.
LMP: What was the genesis of the Leadership Development Capacity Building Committee [the labor-management committee in the Imaging Services department]?
Regina Censullo: After we attended the IHI Conference, people were really excited. Six people attended from Mount Sinai Queens, including Mount Sinai’s Executive Director, Caryn Schwab, 1199 SEIU Vice President Saily Cabral, Rashid Larry, George Lowe, 1199SEIU RN delegate Ludi Victor-Ramos, and me. We convened after the conference, wanting to capitalize on the momentum. With approval from the labor-management executive sponsors, we identified four managers and six union members from different shifts and different areas of imaging. Union leadership and members contributed half an hour of their time for regular meetings, and management contributed lunch and space and the other half of committee members’ time. They all came and contributed. We started on April 28, 2015. From then, we met every two weeks.
George Lowe: Rashid and I did the IHI presentation. We had so many people stop at our storyboard to ask us questions. It validated our work and our relationship. We had a delay with our flight coming back from Florida. Our executive director, medical director, 1199 vice president (Saily Cabral), Rashid, Regina and I got stuck in the airport. We talked and built trust among each other. It was a great opportunity.
When we got back, we shared with the staff what we had experienced. I said, “Let’s see if we can put together a package that we can work on moving forward.” We wanted to create a vehicle that will maintain a higher standard perpetually. We decided to use our labor-management leadership team, to engage them on how to do this. We think our small size and diversity are our strengths. This is the most diverse community in New York. I think we have the most diverse staff in New York. We are not big in size regarding beds. But we are huge in stature and in what we do. We all expect great things from each other. We don’t get it right all the time, but we keep trying.
At the conference, I met people from South Africa and Australia talking about the same issues. We saw that everyone else was working on these issues. I wanted a vehicle that no matter what we did, we could work on it collaboratively.
LMP: Can you explain your process for getting the teams together and deciding on the focus of your specific performance improvement projects?
RC: We spoke to our labor-management sponsors about our resources and time and space. In LMP projects, we always begin with conversations. We need to focus on the strategic goal for the institution and the labor-management team.
The labor-management sponsors wanted to improve turnaround time and patient experience. We created the ten-person committee in Imaging Services. Imaging touches many units in the hospital: all the hospitalized patients that need tests. We knew from experience that improvement of turnaround time does not necessarily guarantee that patient satisfaction scores will improve, so we knew we needed a multi-pronged approach. To develop the strategy, the labor-management committee and we engaged all staff in a brainstorming process that allowed each staff member to have input on ideas and strategies. We decided to work on managing patient expectations and anxiety during slow turnaround times. Staff need to give patients an explanation. The staff weren’t telling patients about the process consistently—what patients should be expecting, what is the duration of time for the test and when they will get test results.
GL: We developed an approach where each area of testing built its own script. The entire staff developed these scripts together. We call it Post-Procedure Communication Scripting (PPCS). Each script is tailored depending on the service: MRI, CT, Echo. We became a real team. It was a give and take process. Once the patients understood the process, they got more comfortable and then the scores rose.
RC: The labor-management facilitators, Rashid Larry and George Lowe, did the brainstorming with the staff. The staff voted collectively on the procedure that was best for them. The scripting comes from that. They chose that as one of their mechanisms for improving patient satisfaction scores. They really felt that their voices were heard.
LMP: You mentioned a multi-pronged initiative. What else did you address?
RC: We also looked at turnaround time. We chose one area that was measurable and looked at how long it takes for testing in the ED. We studied the data for three months and realized that at certain periods the turnaround time was good and other times, it lagged. We looked at who was on the more efficient shift. We looked at the best practices to see what they did to make things faster. We interviewed staff and shadowed them during the process. The team discovered that a best practice was to notice when there was no one waiting, move into the ED, and find a nurse to inform that they are ready to receive a patient. They also asked the patient if he or she was ready. If that patient was not ready, they took the next patient. We decided to implement that with everybody, so this is now a new practice that the staff do to improve wait time and turnaround time.
Soraya Flores: We have PI groups in several other areas: Clean and Clutter, a project with Cardiology that organizes and cleans supply cabinets, MRI and Communications. We all work together for our patients. We give it our time and dedication. We wear many hats here. I am with the PI team with MRI. We had to collect data to see the effectiveness, the delays for the patient—all of these areas we look at to try to make it effective for our department. We looked at the root cause of the problems.
RC: In the MRI area, the staff did extensive root cause analyses. They looked at how to eliminate cancellation of the first appointment. Soraya examined a month of data on causes for this cancellation, then the team worked on how to improve communications so that technologist doesn’t come for a 9 AM appointment which is then cancelled. What do we need to do to get the first patient in? Soraya came up with the idea, now they are working with nursing and with the doctors to problem-solve.
GL: I always look at the first case of the day to see my efficiencies and what time my staff was here. Through Soraya and her data collection, we noticed that cancellations was one of the biggest challenges. The way you start the day really determines your efficiencies for the rest of the day. We began working on that, based on her observations.
LMP: Can you talk about what worked really well and if there were any particular challenges?
SF: Since we are in the Radiology Department, we are really busy people. I am the medical secretary, department purchaser, and the registrar and I handle the POs. For this committee, I am a trainee facilitator and I also take the notes.
GL: I recommended that the team invite more people into the committee, so they saw the real work we did. It isn’t a chance to get free lunch, but to do real work and be responsible. I know our success is not just based on us. It is going to be based on getting the rest of the group to buy in and move forward. That is important for any team.
Rashid Larry: I think what works well is the team cohesiveness. We have everyone in our department, from the transporter to the top level, engaged in solving problems. We tackle problems together. The challenge is, how do we continue this momentum? We have new people on our team: How can we continue with this cohesiveness?
GL: From an administrative position, I couldn’t do it without my labor-management leadership group. It doesn’t work. If everyone does just what their job title says, we won’t be successful in healthcare today. It works when everyone extends themselves a bit more. The evolution of healthcare and the changes with the Affordable Care Act require you to have a team approach. We formed our team, and it drives the bus now.
LMP: How did you create that cohesiveness? Sometimes you bring people together and it doesn’t happen.
RL: I would say the respect for each other. It is not what you say, but how you say it. We listen to each other. It resonates with the team, and it works for us. People went from “Management doesn’t care if I raise an issue,” to “If management doesn’t do it, they will explain why.”
SF: We work together and we work hard. We feel good about what we accomplished so far.
GL: Excellence is a journey, not a destination. We now enjoy the journey. It is so demanding, and it adds stress to your life, but we have to accomplish this for our patient’s sake, our healthcare’s sake, for our financial strength and families.
We are creating a vehicle that helps us move all of this forward so we don’t have to be continually stressed. We are going to work at it until we get it right. That feels good. We have a team that works together. If they say, “I have a problem,” I say “We have a challenge.” Then they say: “We have a challenge.” We may have a challenge all of the time, but we are going to find a way to minimize it and keep moving forward.